Sequential chemotherapy and intensity-modulated radiation therapy in the management of locoregionally advanced nasopharyngeal carcinoma: Experience of 370 consecutive casesReport as inadecuate




Sequential chemotherapy and intensity-modulated radiation therapy in the management of locoregionally advanced nasopharyngeal carcinoma: Experience of 370 consecutive cases - Download this document for free, or read online. Document in PDF available to download.

BMC Cancer

, 10:39

First Online: 10 February 2010Received: 22 July 2009Accepted: 10 February 2010DOI: 10.1186-1471-2407-10-39

Cite this article as: Lin, S., Lu, J.J., Han, L. et al. BMC Cancer 2010 10: 39. doi:10.1186-1471-2407-10-39

Abstract

IntroductionTo investigate the outcome of locoregionally advanced nasopharyngeal carcinoma NPC treated with intensity-modulated radiation therapy IMRT after induction chemotherapy, with or without concomitant chemotherapy.

MethodsBetween August 2003 and March 2007, 370 patients with locoregionally advanced NPC were treated with IMRT. Presenting stages were stage IIB in 62, stage III in 197, and stage IVA-B in 111 patients. All patients except for 36 patients with cervical lymphadenopathy of 4 cm or less in diameter received 2 cycles of cisplatin-based neoadjuvant chemotherapy. Forty-eight patients received cisplatin-based concurrent chemotherapy as well.

ResultsWith a median follow-up time of 31 months range 5 to 61 months, the 3-year local control, regional control, metastasis-free survival MFS, disease-free survival DFS and overall survival OS rates were 95%, 97%, 86%, 81% and 89%, respectively. Multivariate analyses revealed that both age ≤ 60 vs. >60 and N-classification are significant prognosticators for OS P = 0.001, hazard ratio HR 2.395, 95% confidence interval CI 1.432-4.003; P = 0.012, hazard ratio HR 2.614, 95% confidence interval CI 1.235-5.533; And N-classification is the only significant predicative factor for MFS P = 0.002, HR 1.99, 95% CI 1.279-3.098. T-classification and concurrent chemotherapy were not significant prognostic factors for local-regional control, MFS, DFS, or OS. Subgroup analysis revealed that concurrent chemotherapy provided no significant benefit to IMRT in locoregionally advanced NPC, but was responsible for higher rates of grade 3 or 4 acute toxicities 50% vs. 29.8%, P < 0.005. No grade 3 or 4 late toxicity including xerostomia was observed. However, two patients treated with IMRT and neoadjuvant but without concurrent and adjuvant chemotherapy died of treatment related complications.

ConclusionIMRT following neoadjuvant chemotherapy produced a superb outcome in terms of local control, regional control, MFS, DFS, and OS rates in patients with stage IIB to IVB NPC. Effective treatment strategy is urgently needed for distant control in patients diagnosed with locoregionally advanced NPC.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-10-39 contains supplementary material, which is available to authorized users.

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Author: Shaojun Lin - Jiade Jay Lu - Lu Han - Qisong Chen - Jianji Pan

Source: https://link.springer.com/







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